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HCl-induced cell edema in rabbit esophageal epithelium: A bumetanide-sensitive process
A242
AGA ABSTRACTS
• HCl-INDUCED CELL EDEMA IN RABBIT ESOPHAGEAL
EPITHELIUM: A BUMETANIDE-SENSITIVE PROCESS. NA Tobey, EJ Cragoe, Jr., RC Orlando~ Department of Medicine, Tulane University School of Medicine and New Orleans Veterans Hospital, New Orleans, LA. The morphology of acid damage to esophageal epithelium is characterized by marked cell (swelling) edema, an observation suggesting that in the process of acid damage an increase in osmotic forces develops w i t h i n t h e cell that accounts for the increase in:cell water. AIMS: To document that esophageal cells swell at acidic pH and to explore the nature of t h e o s m o l y t e s and mechanisms responsible for it. METHODS: Cell edema was assessed in sections of rabbit esophageal epithelium by correlating morphologic change with change in tissue wet weight following immersion i n acidic solutions for up to 4h. RESULTS: At pH $2 for 2h, tissues gained weight and exhibited cell edema on both light and electron microscopy. In addition to being time and pH dependent, cell edema was dependent ~n bathing solution osmolytes, specifically Na , E + and CI- but not HC03-. Further, this process could b e i n h i b i t e d by tissue pretreatment with bumetanide (or ethacrynic acid) but not by amiloride, 3',4'-dichlorobenzamil or diphenylamine-2-carboxylic acid. CONCLUSIONS: HCI exposure s p o n t a n e o u s l y p r o d u c e s ceil edema in esOphageal epithelium. The pathophysiology of cell edema involves the uptake of bathing solution osmolytes through a bumetanide-sensitive process compatible with a NaK2Cl cotransporter in the epithelial cell membrane. Support:NIH DK36013.
THE GASTROESOPHAGEAL FLAP VALVE AS A NEW TOOL IN THE GASTROESOPHAGEAL REFLUX DISEASE DIAGNOSTIC. E.B.Toneloto; R.J.S.Torresini; C.R.Teixeira; N.H.V. Coelho, Endoscopy Unit, F u n d a ~ o Riograndense Uni versit~ria de Gastroenterologia. Porto Alegre. B r a zil. The gastroesophageal flap valve is a gastric fold created at the point the esophagus enters the stomach. At endoscopic retroflexed~view four different shapes of this valve can be identified. Type I: Mai m tains a tight closure remaining oposed to the endos cope; Type II: Opening ocasionally and closing pro m ptly; Type III: Opening frequently and closing in~ completely and; Type IV: Staying$open all the time. 500 patients examined at our Unit were studied. 348 patients did not have heartburn and regurgitation or macroscopic esophagitis and showed Type I 157 ; Type II 92; Type III 67; and Type:IV 32. 152 pa tients had heartburn and regurgitation or macrosco pic esophagitis. Type I 14; Type II 27; Type III 39 and Type IV 72 (p<0,01). Our study showed there was significant correlation between the gastroesophageal flap valve morphology and the presence of gastroesophageal reflux disease.
GASTROENTEROLOGY, Vol. 108, No. 4
CORRELATION OF TC 99M PERTECHNETATE PLANAR SCANNING WITH BARRETT'S ESOPHAGUS IN CHILDREN. V__. Tolia, S. Kottamasu. Children's Hospital of Mlchl---~-:~-''gan,Detroit. Scintigraphy using pertechnetste labeled with Tc 99m is a useful n o n i n v a s i v e diagnostic procedure for the localization of normal or ectopic gastric mucosa. We prospectively studied 8 patients With endoscopic and histologic Barrett's esophagus (BE) b y performing Tc 99m pertechnetate scanning during 1993-94. The patients age range was b e t w e e n 2-18 years (7 males, 1 female),(4 B~lacks, 4 Caucasians). Five patients had associated m e n t a l retardation. Pertechnetate scan was accomplished after intravenous injection of i0 ~Ci of perteehnetate and imaging was performed in ~ r i o u s views for 30 minutes. Persistent activity along esophagus which did not w a s h off with water swallows was considered consistent with the presence of ectopic gastric mucosa. The study was positive for eetepic gastric mucosa in 5/8 patients. When these results compared with the length of BE on endoscopy, patients with > 5 cm length of severe inflammation in esophagus were the ones who were more likely to have positive scans for ectopic gastrici~ucosa in esophagus. With intensive medicaI treatment using H2 blockers, omeprazole and prokineticagents, BE improved in some patients during s~rveillance endoscopy and histology. Repea~ scans in patients with previously abnormal studie~ s h o w e d ~ b s e n c e o f activity reflecting improved endoscopic I changes. W e suggest that with the current scanning technique , it is easier to identify segments of severe inflammation in esophagus which are >5 cm long. Therefore Tc 99m Pertechnetate scanning can be a noninvasive tool to follow the status of BE.
ERADICATION OF HELICOBACTER PYLORI USING CLARITHROMYCIN, OMEPRAZOLE AND AMOXYCILLIN FOR ONE WEEK KA Tonge, AF Goddard', RPH Logan', PA Gummett, CJ Hawkey', JJ Misiewicz, JH Baron. Parkside Helicobacter Study Group, London & Div of Gastroenterology', University Hospital, Nottingham UK
Introduction:Helicobacterpylori (H.pylori)eradication of > 80% has been reported with two weeks clarithromycin (C1) and omeprazole (Ore) dual therapy. Addition of another antimicrobial may shorten therapy, lower drug dosage, and improve eradication. Methods: Dyspeptic patients undergoing upper GI endoscopy entered the study and received C1 500mg bd and amoxycillin lg bd with Om 20mg mane or Om 20mg bd for one week. Pre-treatment H.pylori positivity was assessed by antral histology, culture, CLO-test or ]m4Curea breath test (UBT). Antimicrobial susceptibility was assessed by disc diffusion or E-testR, and side-effects and compliance by direct questioning. Eradication was determined by UBT alone 4 weeks after the end of treatment. Results: Eighty-three patients (58 male, mean age 45 y) with either peptic ulcer disease (n=55), NUD (n=15) or duodenitis/erosions (n=13) entered the study. Three patients were lost to follow-up. H.pylori was eradicated in 80% (95% CI=65-90) of patients receiving Om 20mg bd compared to 83% (95% CI=67-94) receiving Om 20 mg mane (ns, per protocol analysis). Eradication was not influenced by diagnosis and occurred in all patients (n=3) found to be infected with metronidazole resistant strains. Taste disturbance occurred in 23% Of patients taking Om 20 mg bd and 14% taking Om 20 mg mane (ns) though compliance was still excellent. Five of 15 failures had previously failed to eradicate H.pylori and 2 were infected with CI resistant strains. Conclusions: One week of clarithromycin, amoxycillin and omeprazole is an effective treatment for H.pylori infection and may be of particular benefit for patients infected with nitromidazole resistant strains.
AGA ABSTRACTS
• HCl-INDUCED CELL EDEMA IN RABBIT ESOPHAGEAL
EPITHELIUM: A BUMETANIDE-SENSITIVE PROCESS. NA Tobey, EJ Cragoe, Jr., RC Orlando~ Department of Medicine, Tulane University School of Medicine and New Orleans Veterans Hospital, New Orleans, LA. The morphology of acid damage to esophageal epithelium is characterized by marked cell (swelling) edema, an observation suggesting that in the process of acid damage an increase in osmotic forces develops w i t h i n t h e cell that accounts for the increase in:cell water. AIMS: To document that esophageal cells swell at acidic pH and to explore the nature of t h e o s m o l y t e s and mechanisms responsible for it. METHODS: Cell edema was assessed in sections of rabbit esophageal epithelium by correlating morphologic change with change in tissue wet weight following immersion i n acidic solutions for up to 4h. RESULTS: At pH $2 for 2h, tissues gained weight and exhibited cell edema on both light and electron microscopy. In addition to being time and pH dependent, cell edema was dependent ~n bathing solution osmolytes, specifically Na , E + and CI- but not HC03-. Further, this process could b e i n h i b i t e d by tissue pretreatment with bumetanide (or ethacrynic acid) but not by amiloride, 3',4'-dichlorobenzamil or diphenylamine-2-carboxylic acid. CONCLUSIONS: HCI exposure s p o n t a n e o u s l y p r o d u c e s ceil edema in esOphageal epithelium. The pathophysiology of cell edema involves the uptake of bathing solution osmolytes through a bumetanide-sensitive process compatible with a NaK2Cl cotransporter in the epithelial cell membrane. Support:NIH DK36013.
THE GASTROESOPHAGEAL FLAP VALVE AS A NEW TOOL IN THE GASTROESOPHAGEAL REFLUX DISEASE DIAGNOSTIC. E.B.Toneloto; R.J.S.Torresini; C.R.Teixeira; N.H.V. Coelho, Endoscopy Unit, F u n d a ~ o Riograndense Uni versit~ria de Gastroenterologia. Porto Alegre. B r a zil. The gastroesophageal flap valve is a gastric fold created at the point the esophagus enters the stomach. At endoscopic retroflexed~view four different shapes of this valve can be identified. Type I: Mai m tains a tight closure remaining oposed to the endos cope; Type II: Opening ocasionally and closing pro m ptly; Type III: Opening frequently and closing in~ completely and; Type IV: Staying$open all the time. 500 patients examined at our Unit were studied. 348 patients did not have heartburn and regurgitation or macroscopic esophagitis and showed Type I 157 ; Type II 92; Type III 67; and Type:IV 32. 152 pa tients had heartburn and regurgitation or macrosco pic esophagitis. Type I 14; Type II 27; Type III 39 and Type IV 72 (p<0,01). Our study showed there was significant correlation between the gastroesophageal flap valve morphology and the presence of gastroesophageal reflux disease.
GASTROENTEROLOGY, Vol. 108, No. 4
CORRELATION OF TC 99M PERTECHNETATE PLANAR SCANNING WITH BARRETT'S ESOPHAGUS IN CHILDREN. V__. Tolia, S. Kottamasu. Children's Hospital of Mlchl---~-:~-''gan,Detroit. Scintigraphy using pertechnetste labeled with Tc 99m is a useful n o n i n v a s i v e diagnostic procedure for the localization of normal or ectopic gastric mucosa. We prospectively studied 8 patients With endoscopic and histologic Barrett's esophagus (BE) b y performing Tc 99m pertechnetate scanning during 1993-94. The patients age range was b e t w e e n 2-18 years (7 males, 1 female),(4 B~lacks, 4 Caucasians). Five patients had associated m e n t a l retardation. Pertechnetate scan was accomplished after intravenous injection of i0 ~Ci of perteehnetate and imaging was performed in ~ r i o u s views for 30 minutes. Persistent activity along esophagus which did not w a s h off with water swallows was considered consistent with the presence of ectopic gastric mucosa. The study was positive for eetepic gastric mucosa in 5/8 patients. When these results compared with the length of BE on endoscopy, patients with > 5 cm length of severe inflammation in esophagus were the ones who were more likely to have positive scans for ectopic gastrici~ucosa in esophagus. With intensive medicaI treatment using H2 blockers, omeprazole and prokineticagents, BE improved in some patients during s~rveillance endoscopy and histology. Repea~ scans in patients with previously abnormal studie~ s h o w e d ~ b s e n c e o f activity reflecting improved endoscopic I changes. W e suggest that with the current scanning technique , it is easier to identify segments of severe inflammation in esophagus which are >5 cm long. Therefore Tc 99m Pertechnetate scanning can be a noninvasive tool to follow the status of BE.
ERADICATION OF HELICOBACTER PYLORI USING CLARITHROMYCIN, OMEPRAZOLE AND AMOXYCILLIN FOR ONE WEEK KA Tonge, AF Goddard', RPH Logan', PA Gummett, CJ Hawkey', JJ Misiewicz, JH Baron. Parkside Helicobacter Study Group, London & Div of Gastroenterology', University Hospital, Nottingham UK
Introduction:Helicobacterpylori (H.pylori)eradication of > 80% has been reported with two weeks clarithromycin (C1) and omeprazole (Ore) dual therapy. Addition of another antimicrobial may shorten therapy, lower drug dosage, and improve eradication. Methods: Dyspeptic patients undergoing upper GI endoscopy entered the study and received C1 500mg bd and amoxycillin lg bd with Om 20mg mane or Om 20mg bd for one week. Pre-treatment H.pylori positivity was assessed by antral histology, culture, CLO-test or ]m4Curea breath test (UBT). Antimicrobial susceptibility was assessed by disc diffusion or E-testR, and side-effects and compliance by direct questioning. Eradication was determined by UBT alone 4 weeks after the end of treatment. Results: Eighty-three patients (58 male, mean age 45 y) with either peptic ulcer disease (n=55), NUD (n=15) or duodenitis/erosions (n=13) entered the study. Three patients were lost to follow-up. H.pylori was eradicated in 80% (95% CI=65-90) of patients receiving Om 20mg bd compared to 83% (95% CI=67-94) receiving Om 20 mg mane (ns, per protocol analysis). Eradication was not influenced by diagnosis and occurred in all patients (n=3) found to be infected with metronidazole resistant strains. Taste disturbance occurred in 23% Of patients taking Om 20 mg bd and 14% taking Om 20 mg mane (ns) though compliance was still excellent. Five of 15 failures had previously failed to eradicate H.pylori and 2 were infected with CI resistant strains. Conclusions: One week of clarithromycin, amoxycillin and omeprazole is an effective treatment for H.pylori infection and may be of particular benefit for patients infected with nitromidazole resistant strains.